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Right Ventricular-Pulmonary Arterial Coupling and Exercise-induced Pulmonary Congestion in Heart Failure with Reduced
Matteo Mazzola1, Erica Michelotti2, Nicolò De Biase3
1Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
Aims:
We explored the relationship between right ventricular-pulmonary arterial (RV - PA) coupling and exercise pulmonary congestion in heart failure patients with reduced (HFrEF) and mildly reduced (HFmrEF) left ventricle ejection fraction.
Methods And Results:
A cohort of 118 HFrEF and HFmrEF patients underwent baseline transthoracic echocardiography and exercise stress echocardiography (ESE), assessing extravascular lung water (EVLW) changes through lung ultrasound (LUS) B-lines. The TAPSE/PAPs ratio served as RV - PA coupling surrogate. Compared to patients with ∆B-lines ≤10, those with ∆B-lines >10 displayed a worse RV-PA coupling both at rest (median TAPSE/PAPs: 0.77 mm/mmHg vs 0.57 mm/mmHg, p = 0.002) and at peak exercise (median TAPSE/PAPs: 0.58 mm/mmHg vs 0.39 mm/mmHg, p < 0.001). Worsening RV - PA coupling at peak effort inversely correlated with exercise extravascular lung water increase, but only in patients with higher peak PAPs (peak PAPs 42-55 mmHg; r = -0.53, p = 0.001).
Conclusion:
Exercise may induce impairments in RV-PA coupling which hampers lung lymphatic drainage through elevated central venous pressure and increases EVLW. This is especially true for patients with higher peak PAPs values, in which a significant increase in capillary pressure during exercise can occur in absence of the structural pulmonary alterations observed in more advanced stages of HF.
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